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1 Abuse of Brain Injured Americans in Florida Scandalizes U.S. By David Armstrong Bloomberg News Bloomberg NEWS July 24, 2012 Soon after Peter Price arrived at the Florida Institute for Neurologic Rehabilitation to recover from a brain injury, he pleaded for a rescue. Jess, they beat me up, Price told his sister, Jessica Alopaeus, in May You have to get me out of here. Staffers at his new home held him down and punched him in the face and groin, Price said. When Alopaeus s efforts to transfer him stalled, Price said his desperation led him to a step aimed at speeding his release. He swallowed five fish hooks and 22 AA batteries he d picked up during a patient outing at Wal-Mart. After emergency surgery to remove the objects, he was allowed to transfer to another facility. Residents at the Florida Institute have often been abused, neglected and confined, according to 20 current and former patients and their family members, criminal charges, civil complaints and advocates for the disabled. These sources and over 2,000 pages of court and medical records, police reports, state investigations and autopsies contain an untold history of violence and death at the secluded institute known as FINR, which is located amid cattle ranches and citrus groves in Hardee County, 50 miles southeast of Tampa. Patients families or state agencies have alleged abuse or care lapses in at least five residents deaths since 1998, two of them in the last 18 months. Three former employees face criminal charges of abusing FINR patients one of whom was allegedly hit repeatedly for two hours in a TV room last September. Sparse Care The complaints underscore the problems that 5.3 million brain-injured Americans are having Peter Price is a resident patient at a facility in Bradenton, Florida. He and his family have been instrumental in exposing the problems at his previous facility Florida Institute for Neurologic Rehabilitation in Wauchula, Florida. Photographer: William S. Speer/Bloomberg finding adequate care. Their numbers are growing, according to the U.S. Centers for Disease Control and Prevention, as better emergency medicine and vehicle safety mean that fewer die from traffic accidents, bullet wounds and other causes of traumatic brain injuries. The long-term ills range from memory loss and physical handicaps to the inability to control violent anger or sexual aggression. Yet because insurance benefits for rehabilitation are scarce, less than half of those who need it receive it, according to the Brain Injury Association of America. Organized as a company and operated for profit since 1992, FINR has become one of the largest brain-injury centers in the country, with 196 beds. Three rival providers say they know of no place bigger. Multi-site operator NeuroRestorative, Abuse of Brain Injured 1

2 owned by a holding of buyout firm Vestar Capital Partners, handles more patients. FINR hasn t grown by opening its doors to anyone who needs rehabilitation, customers say. Rather, its marketing is focused on the relative few who can pay bills that reach $1,850 a day. Michigan Mandate That includes those injured on jobs with generous worker s compensation benefits, and carcrash victims in Michigan which mandates unlimited lifetime benefits for automobile injury coverage. Those who have clashed with the company over the treatment of patients say its efforts to keep costs down and extend the duration of stays take priority over care and rehabilitation. All people are to them is a monetary gain, said Jana Thorpe, a professional guardian who removed one of her wards from the company s care in They don t care if they do anything for them. Steven Siporin, another guardian, says he has placed patients at FINR when no one else would take them, and doesn t expect to send more. Is this the best society can do? No, he says of FINR. Is this the best under current options? Yes. Difficult Clients Florida s Department of Children and Families has received 477 allegations of abuse or neglect at FINR since 2005, including 36 that were verified by its investigations, according to records released by the agency. The 36 verified claims and others were referred to law enforcement, according to Erin Gillespie, a spokeswoman for the agency, who said she didn t know what became of the referrals. FINR executives declined to comment for this story and turned down a request to visit its Wauchula, Florida, facility. Owner Joseph Brennick said he preferred to stay out of the news before ending a short phone conversation and directing questions to a lawyer, who said he would not answer them. Abuse of Brain Injured 2 The grounds of The Florida Institute for Neurologic Rehabilitation (FINR) in Wauchula. Photographer: Cathy Kemper via Bloomberg On its website, the company calls itself a leader in brain- injury rehabilitation. In past statements it has said it vends extremely high quality care to very difficult clients aimed at returning them to their homes, doesn t use seclusion and has zero tolerance for resident abuse. Elbow Shots Hardee County prosecutors have charged two FINR staffers with abusing Danny Silva, a 21-year-old autistic patient. Video of the alleged crime shows two large men flanking a smaller figure on a sofa as they punch, elbow and slap him at least 30 times. The blows often come after moans from the man in the middle, which appear to be making it hard for his assailants to hear the TV. Shut up, man, they say in the video, taped by a FINR staffer, according to police. You are getting on my damn nerves, one of the hitters tells the smaller man between two elbow shots. A woman in nurse s clothes shows up in the video to give the alleged victim his medicine. Defendants LaKevin Johnson, 30, and Landrey Johnson, 39, of Fort Meade, Florida, have pleaded not guilty to the charges. Their lawyer didn t return calls seeking comment. Employee McKinley Scott pulled autistic patient Gabriel Allen up from his seat and threw him to the ground last December in a second case, prosecutors say. A video in the case shows a man identified as Scott pushing Allen away from him on a couch, standing him up, kicking his legs out from under him

3 Fiery Fist Reginald Hicks, right, was taken to the cafeteria by a FINR employee and given solid food that lodged in his lungs and killed him last December, according to his daughter, Heather Hicks. Her father, a former mortgage worker injured in a car accident, had a care plan that called for tube feeding because he couldn t swallow, she said. Autopsy findings cited aspiration of food and pneumonia as causes of death. Photographer: Suzonne Shivers via Bloomberg and leaving him curled up on the floor next to a blinking Christmas tree. Scott, 48, has pleaded not guilty to an abuse charge. His lawyer didn t return calls. Positional Asphyxia In an earlier incident, Michael Lieux, a braininjured ex- Marine from Louisiana, suffocated when four FINR employees pinned him face down until he couldn t breathe, according to a negligence lawsuit that won his family a $5 million jury verdict in It was homicide by positional asphyxia, according to the medical examiner for Hardee County. The company denied it was negligent and lost its appeal in the case. Two resident deaths at FINR that same year led to confidential settlements of lawsuits alleging negligence and care lapses that the company denied. In 2009, a FINR staffer pleaded guilty to battery charges after punching out a resident who had scratched him during a restraint. More recently, Reginald Hicks was taken to the cafeteria by a FINR employee and given solid food that lodged in his lungs and killed him last December, according to his daughter, Heather Hicks. Her father, a former mortgage-workout specialist injured in a car accident, had a care plan that called for tube feeding because he couldn t swallow, she said. Autopsy findings cited aspiration of food and pneumonia as causes of death. FINR s marketing appears aimed at acquiring tough behavioral cases, including aggressive patients. Its website features an ad dominated by a clenched, fiery-colored fist One of the Subtle Signs That It s Time for Neurological Rehabilitation, according to the headline. The road to the company s 900-acre spread in Wauchula passes fields of grazing cattle and trees draped in Spanish Moss. It houses 152 beds, with 44 more in nearby apartments and group homes. The secluded, pastoral locale keeps residents from trying to run away, the company has said. Other deterrents, current and former patients say, are the alligators and snakes roaming the property. Family History The facility was once part of New Medico Inc., a chain founded by Charles Brennick, the father of FINR owner Joseph Brennick. A 1992 Congressional investigation highlighted allegations that New Medico staff abused patients and prolonged stays to boost revenues. Joseph Brennick, then a senior New Medico employee, promised to block discharges to keep clients, the final Congressional report said. If one wanted to leave, staffers should all jump all over him as a team until he stays, the report quoted a Brennick memo as saying. Around this time, some of the facilities were transferred to the elder Brennick s sons, according to corporate and real estate records. Joseph, who wound up with Wauchula, has prospered as its owner, according to former staffers. In 1995, he bought South Watch, a gated estate on 62 acres near Sarasota that has a 9,000-square-foot Abuse of Brain Injured 3

4 home and is valued at $1.7 million for tax purposes. Brennick bought 311 acres nearby for $6.4 million in He owns four cars, one a 2004 Maybach 62 luxury sedan valued at $300,000. FINR s main campus is valued for taxes at $11.2 million. Taken Down Ex-residents of FINR said they were frequently taken down or knocked to the floor and restrained by staff, in a routine often accompanied by beatings. They say the take-downs were described by the company as a form of restraint called BARR for Brief Assisted Required Relaxation. Blue mats sometimes used for the purpose are ubiquitous at FINR, according to patients and visitors. I was taken down at least once a week, said Janet Clark, who stayed at FINR from 2006 to 2007 after she was injured in a car crash. Clark keeps a photo from her Wauchula days in which she is expressionless and sports a black eye that she said came from staffers. One time they had me down and one of the staff kicked me in the eye with a boot, said Clark, a former prison guard who now lives on her own in Hillsborough, North Carolina. They were saying shut up, screaming at me. I was hurting so much I couldn t stop. It was terrifying. $310,000 Bill Clark, 55, had behavioral issues while she was recovering, including times when she needed to be restrained, she said, but not with the force or frequency that FINR used. She received no psychological therapy there for her aggression problem although she was paying the company $310,000 a year from a personal injury settlement, she said. Immediate and consistent psychological counseling and psychiatric treatment were clearly indicated for Clark, according to an outside evaluation she obtained from Sally Kolitz Russell, a Miami psychologist, nine months into her FINR stay. The company relies on a network of guardians, case workers, doctors and lawyers to find patients. It has exhibited at the annual National Workers Kenneth Aulph, a former lumberjack who was hit by a car while walking across a highway 12 years ago, said he received little psychological therapy, was assigned useless tasks, and saw patient beatings. Photographer: Cathy Kemper via Bloomberg Compensation and Disability Conference and the National Guardianship Association conference. FINR also cosponsors events for the brain-injured in Michigan, home of the lifetime auto-injury benefit. There were 20 Michiganders at the facility at one point last year, according to court records one for every 10 beds at the facility. Country Club Placements at FINR are often made by guardians in Michigan and elsewhere who control the finances and treatment of patients who have been ruled incompetent by courts. It s human trafficking, said Kenneth Aulph, a former lumberjack who was hit by a car while walking across a highway 12 years ago. Aulph said he received little psychological therapy, was assigned useless tasks, and saw patient beatings after he was sent to FINR by Siporin, his courtappointed Michigan guardian, whose practice handles about 120 wards. I wanted to stay in Michigan where my friends and family are, Aulph said. A Siporin aide showed him a company brochure that made you think you were going to a country Abuse of Brain Injured 4

5 Defendants LaKevin Johnson, left, Landrey Johnson, center, and McKinley Scott are accused of abusing patients at The Florida Institute of Neurologic Rehabilitation (FINR). All three have pleaded not guilty to the charges. Source: Hardee County Sheriff's Office via Bloomberg club, highlighting the lakes, swimming pool and library on the Wauchula grounds, Aulph said. Siporin praised FINR s brain-injury program and added a threat, according to Aulph: If he didn t go to Florida, Siporin would get a court order to put him in a mental institution. better for the $900 a day his insurer was paying. Ken was a cash cow, she said. Calls to Siporin s office often went unreturned, and when she did make contact, he assured her that Aulph was doing well, she said. He stopped resisting a move only after she demanded to know the name of the judge in Aulph s case, Kemper said. Her brother is now in a rehabilitation center in Ann Arbor. Siporin said he worked to return Aulph to Michigan, and was unaware of any Kemper query about the judge. FINR s bills have also been paid by state governments and the District of Columbia. They ve sent patients to Wauchula as wards or when they qualify for state assistance. 21 Recalls Sandpaper Alphabet Siporin promised in June 2009 that Aulph would be back in Michigan by Christmas, according to Cathy Kemper, his sister. Instead he stayed two years. Siporin denied threatening Aulph and said he made no promise about length of stay. Aulph went willingly to Wauchula, Siporin said. After breakfast at FINR, Aulph said would spend three hours weeding in the greenhouse, followed by lunch, then a routine in which he sanded down wooden letters of the alphabet that staff tossed into the trash afterward. Aulph said he was capable of more including the intricately carved birdhouses on display in his Michigan apartment. Patients Restricted Patients were mostly restricted to the areas near their cabins in the evenings and weekends, recreation was rare and the swimming pool pictured in the brochure was filled with cement, Aulph said. Patients say they were rarely allowed near the lakes. Kemper said she pressed Siporin almost as soon as her brother arrived in Florida to get him out and wanted to know why he wasn t getting something Abuse of Brain Injured 5 Over the last four years, D.C. has recalled 21 patients from the facility. The pullout followed a 2008 investigation by the district s designated disabilities advocate that found FINR violated patients human rights and D.C. policies by improperly secluding them in their rooms or using drugs as a form of restraint. The company denied those allegations in a letter to the D.C. attorney general. It said patients weren t restricted to their rooms, only to their cabins. In September 2010, the state of Connecticut placed Melinda Jakobowski, 24, in the company s care. Not brain injured, she had been abused as a child and was one of seven mentally ill or disabled patients the state had placed at Wauchula. By February, Jakobowski was dead. Three resulting state- level inquiries in Florida and Connecticut raised questions about the quality of her care, injuries she received at FINR before her death, Florida s oversight of the company and the accuracy of her autopsy. FINR used BARR on Jakobowski 29 times during her five-month stay compared to just five restraints in the prior five months in a hospital in her home state, according to a report last month by the Connecticut Fatality Review Board for Persons with Disabilities.

6 Busted Lip Jakobowski complained that staffers were hitting her and calling her names, the board said. She had a busted lip and what appeared to be bruising under her left eye about a month before she died, according to a sheriff s office report on a mistreatment allegation it had received. The officers concluded she had not been abused. Although she had a history of self-harm, Jakobowski wasn t showing suicidal tendencies at the end of her stay in Connecticut, the fatality board said. She tried at least six times to harm herself between September and January at FINR, including attempts to hang herself with a phone cord and to wrap a t-shirt and a bedsheet around her neck. Not Breathing The company s plan of care for her required two staff members to be watching her and within arm s length at all times, according to an investigation by Florida s Agency for Health Care Administration, or AHCA. On Feb. 10, 2011, arriving morning shift employees found Jakobowski in her bed just after 8 a.m., not breathing, with her hair wrapped around her neck. She was later pronounced dead at a Tampa hospital. One of the employees tasked with watching her was asleep on a couch, according to the Florida investigations. The other was awake, but not observing Jakobowski for at least 15 minutes, the Florida Department of Children and Families determined. Both staffers were fired, the agency said. A month before she died, Jakobowski told her caregivers it would be easy for her to quickly kill herself because overnight staffers slept, according to an internal FINR document cited by Connecticut investigators. It will only take like 3 minutes and by the time they even know it, I ll be dead and happy, the report quoted her as saying. Obvious Flaws The medical examiner in Tampa ruled her death Sudden Ventricular Arrhythmia due to Schizophrenia. The sheriff s office closed its Janet Clark, a former patient at The Florida Institute for Neurologic Rehabilitation (FINR) appears in this undated handout photo taken in Wauchula, Florida. Source: Janet Clark via Bloomberg investigation based on that finding, saying Jakobowski died of natural causes. The Connecticut report said there is no record of a schizophrenia diagnosis for Jakobowski. FINR records indicate she had bipolar disorder. There are obvious flaws in the investigations conducted by Florida agencies and there appear to be weaknesses in the system of oversight and monitoring of the FINR facility and its program, the report said. Mary Mainland, the Tampa medical examiner who conducted the autopsy, said she doesn t remember how she determined Jakobowski was schizophrenic. It doesn t really change the essence of the diagnosis because sudden cardiac death has been seen in other mental illnesses, she said. Florida s AHCA found no violations of its regulations and referred the case to the state Department of Health for further review. The health department was unaware of the referral for more than a year until Bloomberg News recently asked about it. Wrong License We are working with AHCA to resolve this issue, said Victor Johnson, director of the department s unit that includes its Brain and Spinal Cord Injury Program. FINR s license doesn t allow it to treat mentally ill patients like Jakobowski who are not brain injured, said Thom DeLilla, the program s chief. Abuse of Brain Injured 6

7 Meanwhile, Connecticut s Department of Mental Health & Addiction Services considers FINR to be a safe and effective placement, according to James Siemianowski, a spokesman for the agency. He said the treatment of patients is monitored monthly and that clients must agree to be placed there. Allegations that FINR limits residents contact with the outside world have surfaced in court cases in which they sought to oust Siporin as their guardian so they could leave the facility. Three Cases In three such cases since 2010, patients were allegedly blocked from traveling to Michigan for hearings after the company or Siporin told the court they couldn t be safely transported, or that it would require too many staff members. When patient Gabriealle Weakley s lawyer called her at the facility days before the hearing in her case, FINR imposed a one-minute limit on their conversation, according to notes from company employees that are part of the court record. The notes indicate that privacy and liberties were limited in other ways. A supervisor confiscated printouts of s Weakley received from outside because Siporin didn t allow communication with the man who sent them, the FINR notes say. The man was a boyfriend who brought Weakley items she wasn t allowed, such as cameras and cellphones, according to Siporin, who prevailed in court. The notes include detailed quotes from patient conversations with relatives, and discuss residents who were prohibited by the company from making and receiving phone calls. Several patients say they were blocked from sending mail from the FINR, and that s were barred or limited. Prison Preferable You have more freedom in prison and at least there you know when you are getting out, says Elmer Cerano, executive director of Michigan Protection and Advocacy Service Inc., that state s advocate for the disabled. Michigan Protection represented Lori Johnson, a patient who wanted to remove Siporin as her guardian and leave Wauchula. She lost in court, where Siporin cited his years of experience with the brain-injured and said FINR was the best place for her. Price, 24 years old and brain-injured since a bicycle accident at the age of eight, said he wanted to leave FINR after he was punched in the face and groin there in May Alopaeus, his sister and legal guardian, supported the move. Siporin, who was coguardian, opposed it. FINR s treatment of Price was inhumane, said Alopaeus. Price had a busted lip and bruises that could have come from BARR restraints, according to a sheriff s deputy report dated May 8 of that year. Price had been trying to fight with staffers when they stopped him from leaving his cabin four days earlier, the report said. Body Sheet FINR recorded his injuries in a Body Sheet diagram Alopaeus said the company gave her. Under location of bruises, scrapes, scars, rashes etc., the diagram notes blue discoloration around his left eye, one testicle larger than the other, and other discoloration on his arms and chest. The sheriff s office concluded there was no evidence of abuse, and said Price changed his story several times about which staffers were involved in the incident. Price was taken down more than 20 times and confined to his cabin at FINR for weeks at a time, he said in an interview. Residents are kept in as part of Therapeutic Cabin Based Programming, used to protect them from hurting themselves or others, the company has said. Price had kind words for staff members who brought playing cards and music to his room. Others were malevolent, including one who allegedly placed a clipboard over his chest, punched him repeatedly, and told him the method would not leave bruises, Price said. Fish Hooks After one period of seclusion, he said he was allowed to go to Wal-Mart, where he bought the batteries and fish hooks that he later swallowed. Price Abuse of Brain Injured 7

8 also cut his belly and stuffed two of the batteries and eight hooks into the wound. I planned this as a way to get out of FINR, Price said. My plan wasn t to die. It was a month before he recovered from the surgery to remove the objects. He never returned to FINR, and Siporin agreed to give up his guardianship. Price now lives in an apartment run by a different center in Florida, where he is monitored, but able to leave his apartment most days. He said he goes on fishing trips, eats out, sees movies, and has never been taken down at his new home. Editors: Gary Putka, John Voskuhl Abuse of Brain Injured 8

9 Brain-Injured Endure Nursing Homes Without Care Giffords Had By David Armstrong Bloomberg News Bloomberg NEWS December 28, 2012 Larry Boswell sat slumped in a wheelchair. His sweatpants were soiled, his T-shirt soaked in saliva. Flies buzzed around his head. He was able to walk when he arrived at Illinois Cobden Rehabilitation and Nursing Center in 2008, government records show, something he can t manage now. Speech therapy for the 57- year-old ended shortly after he was admitted, according to a lawyer trying to persuade Medicaid to transfer him. While much of what Boswell says is incomprehensible, he managed a clear no when asked if he wanted to stay where he was. Cobden officials didn t respond to telephone calls. Boswell is one of nearly 244,000 brain-injured people consigned to nursing homes, according to data compiled by Bloomberg from U.S. Medicare and Medicaid statistics. He s also on the front line in a national battle to get people like him out of facilities that aren t equipped to care for them. People used to be put away in state hospitals and state developmental centers, said Steven Schwartz, a lawyer who filed a class-action lawsuit to force Massachusetts to provide alternatives to nursing homes for the brain-injured, and won a settlement that s still being implemented. Now people with brain injuries are warehoused and put away in nursing homes. Over 4 million brain-injured Americans including victims of car accidents, assaults, strokes and falls suffer from long-term disabilities that require specialized therapies. They are sometimes neglected in institutions designed for geriatric care, not for the treatment they need. In some cases, they re in facilities with low scores from a U.S. agency that grades nursing homes on quality, cleanliness and other measures. Inhumane Treatment The minute you step behind the curtain and look Few receive the care former U.S. Representative Gabrielle Giffords had after she was shot in the head last year outside a Tucson supermarket. Citing the disparity highlighted by her case, her staff has called for an end to the treatment gap. Photographer: Spencer Platt/Getty Images at what is going on with these people, it is nauseating, said Geoffrey T. Manley, a neurosurgeon and co-director of the Brain and Spinal Injury Center at the University of California, San Francisco. What we are doing to them is inhumane and wrong. Most Americans don t have insurance that will cover brain injury rehabilitation facilities, which handle about 40,000 patients. Insurers generally put sharp limits on the type and duration of long-term care they ll fund. That means the most severely braininjured often end up on Medicaid, the federally- and state-funded insurer for the poor and disabled. While U.S. law requires Medicaid to pay for nursing homes, the program has no such mandate for long-term care in a specialized brain-injury rehabilitation center, a person s home or a group residence. There are some Medicaid-paid slots about 19,000 nationwide for the brain-injured outside nursing homes. Waiting lists for these exceed five years in some states, and officials say there isn t enough money to expand them. Brain-Injured 1

10 Treatment Gap Few receive the care former U.S. Representative Gabrielle Giffords had after she was shot in the head last year outside a Tucson supermarket. Citing the disparity highlighted by her case, her staff has called for an end to the treatment gap. Giffords, 42, spent five months at the TIRR Memorial Hermann rehabilitation center in Houston, Texas, with the bill paid by federal workers compensation insurance. Her assailant, firing a handgun, killed six others in the attack. In Houston, Giffords had music, speech, physical and aquatic therapy. TIRR Memorial Hermann brain injury teams include a rehabilitation physician, a neuropsychologist, a dietitian and a pharmacist. That s hard to match in a nursing home. Fewer than one in 10 can care for a clientele with such extensive needs, said Scott Schuster, president of Wingate Healthcare, which owns 18 nursing homes in Massachusetts and New York. The system is not designed to care for braininjury patients, Schuster said. Less Restrictive Wingate this month closed a 125-bed center in Middleboro, Massachusetts, that specialized in treating brain injuries because the Medicaid rate of $320 didn t come close to covering the services patients needed, Schuster said. More than a quarter of the brain-injured in nursing homes are capable of living in lessrestrictive environments, said Susan Connors, president of the Brain Injury Association of America. University of Wisconsin researchers found that 19 to 22 percent of patients wanted communitybased care in a 2009 study funded by the U.S. Centers for Disease Control and Prevention. Bloomberg found 243,892 brain-injured patients in Medicaid- or Medicare-certified nursing homes using admissions data the homes are required to file to the government. They were culled from the 1.3 million total patients in the database by searching it for files containing the codes for brain injuries. No License The Boswell case illustrates the byzantine snarls in brain- injury care. He wants to live in one of the apartments or group homes in Carbondale, 15 miles away, that offer tailored brain- injury therapies and are operated by NeuroRestorative Inc. But the Illinois Medicaid program will only cover long-term care in a licensed nursing home and NeuroRestorative doesn t have a nursing home license. Boswell s lawyer, Stacey Aschemann, said she s petitioning the Medicaid program to consider transferring her client to NeuroRestorative anyway. While Medicaid pays $118 a day for Boswell to live at Cobden, and NeuroRestorative would charge $390 a day for someone in his condition, money doesn t seem to be the issue. Illinois Medicaid pays $666 a day to send some state residents to a brain injury treatment center in Omaha, Nebraska, that has a nursing home license. Boswell doesn t want to leave Illinois and his family, Aschemann said. Olmstead Decision In Massachusetts, a 2008 promise by the state to help nearly 2,000 brain-injured live outside nursing homes has led to only a few hundred placements, according to Schwartz, a lawyer for the nonprofit Center for Public Representation. The promise was made in the settlement to the suit Schwartz filed on behalf of 9,400 brain-injured patients in the state. The suit cited the U.S. Supreme Court s 1999 Olmstead decision that the disabled have the right to live in their communities if they aren t opposed and their placement can be reasonably accommodated. After the settlement, one plan to move about 1,600 patients out of nursing homes was shelved, Schwartz said, and he and state officials are still working on finding a way to meet the terms of their agreement. Paulette Song, a spokeswoman for the Massachusetts Medicaid agency, declined to comment on the case. There s no question nursing homes are sometimes the best option, especially for people on Brain-Injured 2

11 old Ferrier has been at Aurora Senior Living of East Hartford. Her income is $1,126 a month in Social Security disability, all but $60 of which goes to Aurora. Disjointed Thoughts An ambulance enters the Texas Institute of Rehabilitation and Research (TIRR) in Houston, Texas where U.S. Representative Gabriel Giffords underwent rehabilitation. Giffords had music, speech, physical and aquatic therapy. TIRR Memorial Hermann brain injury teams include a rehabilitation physician, a neuropsychologist, a dietitian and a pharmacist. Photographer: Eric Kayne/Getty Images ventilators or requiring feeding tubes. But the majority need therapeutic attention nursing homes can rarely provide. Expanding Possibilities And nursing homes don t necessarily want to take these patients on, said Greg Crist, a spokesman for the American Health Care Association, a Washingtonbased trade group. Our guiding principal, particularly with young people, is that we want them in the least restrictive care setting possible, Crist said. We don t want them if they don t belong in our center. In 24 states, U.S. Medicaid officials have granted waivers that expand the possibilities for people disabled by brain injuries. These include paying for rehabilitation therapy and for living at home or in community settings such as staffed apartments and small group houses. Funding for the waiver programs is modest; most states limit how many people can participate, creating long waiting lists for those services. In Connecticut, Jean Ferrier s request to live in the community under the waiver program has been pending for more than three years, according to her sister, Patty Van Etten. Since June 2011, the 50-year- Ferrier had just turned 17 when she was thrown from a Jeep her boyfriend was driving, sustaining injuries so extensive doctors doubted she would walk or talk again, according to Van Etten. She proved them wrong. With a brace on her right leg, Ferrier limped to a booth for lunch at a Denny s near Aurora and spoke haltingly. She suffers from aphasia, a common effect of brain trauma that results in disjointed thoughts and broken sentences. I would like to live somewhere else, she said. When asked where, she struggled and sighed before changing subjects. After rehabilitation, Ferrier lived by herself for nearly a decade with family helping with laundry and shopping. After she was assaulted by a man who stole her car, she moved in with her mother. Her sister hired caretakers when their mother turned too frail to help, until that became too expensive. One Star Van Etten said the only place that would take Ferrier was Aurora. She eats meals in her bed and goes outside only when her sister comes to visit or during four scheduled smoking breaks. Her sister said she s not getting needed vocational and occupational therapy. Officials at Aurora didn t respond to telephone calls. It has just one star in the rankings by the Centers for U.S. Centers for Medicare & Medicaid Services, with three times the state s average number of health deficiencies since No nursing home in the state offers specialized care for patients like Ferrier, according to Melinda Montovani, of the Brain Injury Alliance of Connecticut. Most facilities simply will not take someone with a brain injury, as it is not cost effective at rates paid by Medicaid, Montovani said. In New York, Medicaid pays for 173 brain-injured Brain-Injured 3

12 patients at Northeast Center for Special Care in Lake Katrine, a nursing home that specializes in the condition. The cost is between $287 to $491 a day per patient. Cruel Allen Northeast Center has a rating of two stars in the federal ranking system. The most recent state inspection in November 2011 found strong urine odors in the dining room and hallways, and broken, stained furniture. Two men, one an ex-employee, told police in 2009 that the facility wasn t taking seriously a complaint they made about patient abuse. Northeast Center officials denied that was the case when contacted by law enforcement. The two men said a worker, Allen Dinga, sent them videos of himself abusing a 66-year-old, wheelchairbound man with a traumatic brain injury, according to a police report. Detectives discovered a dozen videos, taken over a six-week period. The videos, with titles like cruel allen ha ha and cruel allen smack, show Dinga verbally abusing and swearing at patient James Jackson, slapping him in the head and asking if he can urinate in his bed. In one scene, Dinga flicks a lighter and says, I will light you on fire. Burn Marks The victim s stepson, Jimmie Singleton, said a family member found burn marks on Jackson s arm the next day. The family didn t learn of the video until weeks later. Dinga pleaded guilty to endangering an incompetent person and received three years probation. He couldn t be reached for comment. Officials at Northeast Center didn t respond to calls. New York disclosed last year that 700 Medicaid recipients were living in out-of-state nursing homes. A majority suffered from neurobehavioral disorders, including brain injuries, and a significant percentage were in other states because of New York providers inability to hire and train competent staff, according to a state Medicaid report. Marek Ross, one of the New York outplacements, is fighting in court to come home. Ross, 41, lives in a locked unit at Holyoke Rehabilitation Center, a nursing home in Massachusetts. New York Medicaid sent him there in 2009, claiming there were no other options, Ross says in a lawsuit filed in federal court in Syracuse in June. He has been warehoused in a locked facility out of state, out of sight, and out of mind, his lawsuit alleges. Telephone Privileges At Holyoke, which has four stars in the federal rankings, Ross shares a room with another patient and claims many of his belongings have been stolen. He s allowed outside twice a day, his mail is monitored and his telephone privileges are restricted, the lawsuit claims. He must earn the right to attend church. New York Medicaid is paying $412 a day for his care. Holyoke takes very seriously the personal needs and rights of its patients and its obligations to and responsibility for them, according to an ed statement. Officials declined to comment specifically on Ross s case. His placement in the nursing home violates the Americans with Disabilities Act by subjecting him to unjustified segregation, his lawsuit claims. He wants the court to force New York to transfer him. The state has denied violating Ross s rights, and requested a dismissal of the complaint. In Illinois, Larry Boswell is also looking for a way out. He was in a coma for nearly two months after a car crash three decades ago. He was 24, and a longhaul truck driver. Easily Agitated The accident left him with physical injuries that made walking difficult. He was easily agitated and prone to outbursts. He would make inappropriate remarks to women. With help from family and attendants paid by Medicaid, Boswell lived in apartments and other community settings for much of the last 30 years. He ended up in the Cobden nursing home in 2008 after two caretakers with whom he lived said they could no longer look after him. Brain-Injured 4

13 When two visitors recently saw him at Cobden, Boswell beseeched them to take him to a local park. He began to rise out of his wheelchair, saying he could walk and get into a car without assistance. Aschemann, his lawyer, said he rarely leaves the nursing home, and usually only for medical appointments. The state agency that licenses nursing homes in Illinois identifies Cobden s owner as Steven Blisko, and lists him as having interests in eight other nursing homes in the state. Blisko didn t respond to telephone calls. Stale Air Larry Boswell, 57, seen here in his high-school yearbook photo, was in a coma for nearly two months after a car crash three decades ago, at the age of 24. Boswell is one of nearly 244,000 brain-injured people consigned to nursing homes, according to data compiled by Bloomberg from U.S. Medicare and Medicaid statistics. Source: Bonnie Vaughn via Bloomberg This program is the end of the line, said Bonnie Vaughn, executive director of the Southern Illinois Center for Independent Living, a nonprofit that helps disabled people live in community settings. When Boswell was admitted, a physical therapist indicated he was able to walk 25 feet and follow commands. The therapist noted it was difficult to understand him, according to a report that doesn t identify him but contains details such as date of admission that make clear Boswell is the resident described. Relatively Young Vaughn, who has known Boswell for nine years, said the nursing home won t allow him to walk, even after a doctor wrote an order for a special walker that reduces the chances of him falling. Walking has always been the most important thing to him, she said. He is relatively young. If walking is a major component, why can t we make that happen? At Cobden, the floor of Boswell s shared room was layered in grime. There were two plastic chairs, a broken television and a white sheet covering the window. Flies dotted his bed pillow. The stale air smelled of urine. Patients in common areas appeared to have little to do. Several walked the halls asking visitors for cigarettes or money. A 2008 inspection during the month Boswell arrived cited the home for failing to keep it free of pests. The state inspector reported flies landing on patients incapable of swatting them away and indicated staff did nothing about it. While the federal rankings give Cobden the highest grade of five stars, state inspectors in May noted a strong pervasive urine odor upon entrance to the facility s dining room. They described dirty debris on the floor of a resident s room, missing floor tiles and the entire length of a hallway marked with a dark smeared substance. Aschemann said Boswell deserves a chance to live in another environment. He has made it pretty clear he doesn t want to be there anymore, she said. He had once lived out in the community, and he wants to get back. Editors: Gary Putka, Anne Reifenberg Brain-Injured 5

14 Florida Caregivers Bloodied Patients as Complaints Drew Laughter By David Armstrong Bloomberg News Bloomberg NEWS December 14, 2012 Caregivers at a Florida center for the brain-injured beat patients, goaded them to fight each other and fondle female employees and in one instance laughed at complaints of mistreatment, according to investigative reports released under a court order to Bloomberg News. The center, the Florida Institute for Neurologic Rehabilitation, is fighting a state directive that it move about 50 patients to other facilities. That order followed a Bloomberg story revealing a history of violence at the center southeast of Tampa. At least five patients have died from alleged abuse or neglect there since 1998, two in the last two years. The newly released records summarize 15 probes conducted by the Florida Department of Children and Families since 2008, including 12 that have never been disclosed before. Leon County Circuit Court Judge Kevin J. Carroll ordered the state to provide the reports, with the names of victims blacked out, after Bloomberg petitioned the court, arguing there was a compelling public interest. The Wauchula-based facility, known as FINR, draws patients from across the U.S. and abroad and is said by competitors to be the largest such rehabilitation center in the country. It often finds customers among the relatively few brain injured with legal settlements or insurance payments that enable them to pay premium prices. FINR charges some of them $300,000 a year. In all of the 15 cases summarized in the reports involving 17 patients and 20 staff members the allegations were classified by investigators as verified, meaning they were supported by a preponderance of credible evidence. Difficult Population Until now, the state had released only a summary of complaints, indicating there have been 526 allegations of abuse and neglect since Of those, The grounds of The Florida Institute for Neurologic Rehabilitation (FINR) in Wauchula. Photographer: Cathy Kemper via Bloomberg 37 were deemed verified. Another 117 fell into a category defined by state regulations as when there is credible evidence that does not meet the standard of preponderance. The rest are still being investigated or involved cases where the agency discovered no evidence of abuse. Joe Brennick, FINR s owner and chief executive officer, declined to comment on individual cases. In an ed statement, Brennick said the center has consistently acted in the best interest of its patients, and has one of the toughest self-reporting policies in place for a facility of its kind. It is important to understand that FINR serves one of the most difficult populations of patients in the country, he said, and that these patients often act out aggressively and are extremely difficult to manage. This is not to absolve wrongdoing by staff members, but is a fact that is often overlooked in media reports. Aggressive Behavior NeuroRestorative, a company that operates facilities in Florida under the same type of license as FINR, didn t have a single verified abuse complaint during the same time period as the 526 were lodged Florida Caregivers 1

15 against FINR. NeuroRestorative has about half the number of beds as FINR, which has 196. Among the cases in the recently released records is one from August 2008, when an investigator verified 10 instances of abuse against three autistic patients by three FINR employees. In one incident, as two staffers watched and did nothing, a third named Tilmon Strickland allegedly punched an autistic patient in the face, drawing blood, according to the report. Staff members attempted to cover up the incident by writing an internal report that blamed the patient s injuries on a peer, according to an allegation in the state report. Strickland and another employee, Troy Gordon, had a history of trying to get residents to fight one another and would agitate them and instigate aggressive behavior, according to a summary of allegations against them. Take Down The two staff members encouraged a patient to hit other residents, the report stated. In addition, Strickland and Gordon repeatedly told a patient to inappropriately touch and kiss a female employee, according to the report. The victims were described in the report as easy targets. The investigator wrote that the staff at this facility has been investigated several times for injury and inadequate supervision of the residents. While the workers in this case were fired, according to the report, the facility has other staff who may exhibit similar behavior with residents. Stickland, Gordon and the other now-former FINR employees mentioned in the reports couldn t be reached for comment. In June 2010, a patient who banged his head into a wall after becoming upset was restrained with a technique called BARR, for Brief Assisted Required Relaxation. Several patients told Bloomberg they were beaten during this procedure, which is referred to by residents as a take down. No Contest Done properly, patients hurting themselves or others are supposed to be gently lowered onto a blue mat and restrained for a short period of time until they re calm. In this case, FINR employee Taiwan Blandin allegedly attacked the patient, Demarcus Denton, for no reason during a BARR restraint. Blandin stood over Denton and punched him in the head 10 times before dropping his knee on him several times, according to a police report filed after officers interviewed staff members who said they witnessed the incident. Denton, who suffered a brain injury as a child, was taken to the hospital with a cut to his ear and abrasions on his face. Blandin was arrested and pleaded no contest to a battery charge, receiving a sentence of a year of probation, according to the state attorney s office. In a September 2009 case, FINR employee Thelinor Jena allegedly punched a patient who had scratched him earlier in the day during a BARR procedure, according to the records. Jena pleaded no contest to battery and was placed on probation for a year and ordered to attend an anger management class, according to the state attorney s office. Police Report Another of the investigative reports alleged that in April 2010, employee Kristopher Rossman was recorded on a surveillance camera taking down a patient for nothing. Rossman allegedly moved the patient off-camera, to his bedroom, where the patient emerged with bruises, according to the report. A patient was quoted in a police report as saying he heard sounds of a beating in the bedroom, including yelling and screaming and banging around. Police said the 40-year-old brain-injured man had a large bruise on his back with the shape of a handprint in the middle of it. After the incident, Rossman allegedly told another employee, this is how we do it in this cabin, according to the police report. A video camera caught Rossman and another employee laughing with each other directly after the incident, according to the police report. Battery Charge Rossman was charged with abuse of a disabled person. The charge was later dropped by the state Florida Caregivers 2

16 attorney s office after it determined the allegation couldn t be proven beyond a reasonable doubt, a spokesman for the office said. The July 24 Bloomberg story reported on the cases of three other staffers who were arrested, including LaKevin Johnson and Landrey Johnson, charged in September 2011 with abusing Danny Silva, an autistic patient. Video of the incident shows the two men sitting on either side of the smaller victim on a sofa as they punch, elbow and slap him at least 30 times. It appeared they were hitting him for the simple reason that they could, a state investigator concluded. They were each sentenced to a year of probation last month on a charge of battery, according to the state attorney s office. The lawyer for the two men, Karen Meeks, didn t respond to telephone calls. Praising FINR Silva s father praised FINR in a letter, posted on a company website, that said the center had taken every possible step for corrective action and that his son was receiving the proper care he deserves. In the other case, employee McKinley Scott was videotaped in December 2011 pulling an autistic patient from his seat and throwing him to the ground. Scott was charged with abusing the patient. A Hardee County jury found him not guilty in October. Scott couldn t be reached for comment. The newly released investigative files include cases where employees were faulted for failing to properly watch patients, allowing some to hurt themselves. In October 2008, a woman with a history of swallowing objects was able to consume a pen when the staff person assigned to watch her fell asleep during her shift, according to the files. In December 2010, another patient with a similar history swallowed a piece of a CD, a report said. Two employees were assigned to watch that patient and stay within a certain distance at all times to prevent her from ingesting foreign objects; instead, one worker was around the corner talking on the telephone and the other was in the hallway texting, according to the report. Black Eye In that case, the patient alleged she was routinely beaten by staff. While the investigator was unable to verify that, the report noted the patient had a black eye, a mark on her chin, bruises on her knee and a brush burn on her buttocks. The investigator speculated the injuries could have been the result of staff efforts to restrain the woman, who has behavioral issues. Still, the investigator wrote she had concerns due to the nature of and amount of injuries; some of the explanations do not seem plausible. The investigator also said she witnessed two staffers laugh at the alleged victim in the presence of a company official who said nothing/did nothing to stop the staff members. In a June 2012 case, a patient alleged a staff member grabbed him by the genitals and squeezed hard. While the investigator was unable to substantiate the complaint of physical abuse, the FINR employee did admit to charging the patient $5 every time he wanted to take a smoking break, according to the investigative report. Facebook Page FINR has rarely been punished by regulators in Florida, where there has been confusion among agencies regarding which has oversight. It s been fined once since 2005, paying a penalty of $4, for failure to file a timely renewal application. State officials have said they re working more closely together. Three state agencies staged an unannounced inspection in August. The center responded to heightened regulatory scrutiny by hiring 10 lobbyists. The company has created a Web site, Twitter feed and Facebook page, all under the heading Support FINR, and produced video testimonials from satisfied patients. Editors: Gary Putka, Anne Reifenberg Florida Caregivers 3

17 Florida Ended Patient Death Probe at Private Brain-Injury Center By David Armstrong Bloomberg News Bloomberg NEWS August 1, 2012 State regulators ended inquiries into a patient s death and alleged abuse at the Florida Institute for Neurologic Rehabilitation last year over doubts about their legal authority. The 196-bed institute, a closely-held company known as FINR, is one of the largest brain-injury centers in the U.S. and draws patients from around the country. The Florida Department of Health brought an end to inquiries over the February 2011 death of Melinda Jakobowski, a mentally ill Connecticut woman sent to FINR, after other state regulators had already concluded there were care lapses in her case, according to inter-agency s reviewed by Bloomberg News. The s also showed a top Department of Health official believed FINR was operating outside its brain-injury license in treating Jakobowski and others who didn t have such injuries at its facility in Wauchula, 50 miles southeast of Tampa. The department has taken no action against FINR over the alleged unlicensed care. The state s decision not to further scrutinize the brain- injury company preceded a second death in Wauchula last year and charges of criminal abuse of FINR residents by employees. Patients families or state agencies have alleged abuse or care failures in five FINR residents deaths since 1998, as reported by Bloomberg News last week. FINR denied the allegations in three of those cases, which led to lawsuits. One resulted in a $5 million verdict against the company and the other two ended in settlements. FINR has declined to comment on the Jakobowski case or the later death, which have not been the subject of any lawsuits. Proactive Approach Officials from three Florida agencies will meet tomorrow to discuss cases at FINR, said Victor Johnson, a state Department of Health Official who oversees its brain-injury program. All of us have to change the way we have done or responded to these issues in past, Johnson said. We want to go with a more proactive approach to respond to these issues with one state response. Wayne J. Miller, a lawyer for FINR, said there is probably no health care provider in the state that has as much oversight. He said the facility is subject to inspections and regularly visited by police, state agencies, disabled-protection groups, guardians, family members and others. When a problem is identified at FINR it is immediately evaluated and corrected, Miller said. Jakobowski, 24, died five months after the state of Connecticut sent her to FINR. She was found unresponsive in her bed with her hair wrapped around her neck and died later at a Tampa hospital in what was ruled a cardiac arrhythmia. s Released Florida released internal s in that case and others to Bloomberg News under an open records law request. Although her name was redacted, Florida officials confirmed Jakobowski is the person referenced in the s. Three Florida agencies that deal with FINR the Department of Children and Families, the Agency for Health Care Administration and the Department of Health passed their findings in the case around internally, the s show. None of the agencies believed it had authority to take regulatory action. An AHCA investigation found that FINR failed to maintain proper supervision of Jakobowski and that she was left alone despite a history of trying to hurt herself. It said in an e- mail that it had no authority to regulate patient treatment and sent a request for further investigation to the Department of Health. Florida Ended 1

18 Reimbursement Sought William Reineking, the administrator for the brain-injury program in that department, responded in April 2011 that he might not investigate the case unless his office was reimbursed for its costs. The case provided evidence again that FINR is treating people not covered by the license, Reineking said in another to AHCA the following month. Although Jakobowski was suffering from mental illness, she was not brain-injured. The health department says it only has the authority to regulate the care of FINR patients under a transitional living facility license covering those suffering from traumatic-brain or spinal-cord injuries. Both the health department and AHCA, which licenses health- care facilities, declined to say why the state has permitted FINR to treat patients at its braininjury center when they don t have brain injuries. Regulatory Gap Other cases of alleged abuse involving patients who were severely mentally ill or autistic, but not brain-injured, also have fallen into the regulatory gap, the s show. When the children and families agency later forwarded an abuse allegation of an unnamed patient at FINR to Reineking, he quickly responded that there was nothing he could do. The patient was not admitted with a TBI or tramautic brain injury as defined in law and rule, he wrote in an August We do not have authority or jurisdiction to intervene. Thank you for sharing this information. One month after that , a 21-year-old autistic patient at FINR was allegedly abused over a two-hour period by two staffers who took turns elbowing, punching and slapping him. The staffers face pending charges of abusing a disabled person. In December 2011, a second autistic man was allegedly knocked to the floor by an employee who also has been charged by prosecutors. All three staffers were fired. They have pleaded not guilty to the criminal charges. Another Death The same month, just after Christmas, another FINR patient died. Reginald Hicks was taken to the cafeteria by a FINR employee and given solid food that lodged in his lungs and killed him, according to his daughter, Heather Hicks. Her father, who was injured in a car accident, had a care plan that called for tube feeding because he couldn t swallow, she said. Autopsy findings cited aspiration of food and pneumonia as causes of death. William Dartland, executive director of the nonprofit Consumer Federation of the Southeast, called for state and federal officials to take immediate action to protect patients at FINR. If authorities need to take over control of the facility to ensure the patients are safe, then that s what needs to happen now, said Dartland, a former deputy attorney general in the state. Editors: Gary Putka, John Voskuhl Florida Ended 2

19 Florida Orders Brain-Injury Center to Move Half of Patients By David Armstrong Bloomberg News Bloomberg NEWS August 23, 2012 A Florida brain-injury center facing allegations of abuse has been ordered to move dozens of its patients to other facilities, according to a state report released today. The Florida Institute for Neurologic Rehabilitation, one of the largest facilities of its kind in the country, is treating patients without brain injuries a breach of its license, say Florida regulators. During a surprise inspection earlier this month, state officials say they found that 50 of 98 patients whose records were reviewed did not meet the licensing criteria for treatment at the center s main facility near Wauchula, about 50 miles Southeast of Tampa. The state said the institute, commonly called FINR, must submit a plan to relocate those patients to a facility that is appropriate to meet their needs. The Florida Agency for Health Care Administration also found that FINR was keeping patients too long, another violation of its transitional living facility license. It ordered the center to develop a new protocol for discharging patients. Wayne J. Miller, an attorney representing FINR, didn t immediately return messages seeking comment. Surprise Inspection Investigators from three state agencies conducted a surprise inspection on Aug. 2 and 3 following a Bloomberg News report of dozens of cases of alleged abuse and neglect at the facility. FINR, a for-profit company, treats patients from across the country. Patients families or state agencies have alleged abuse or care lapses in at least five residents deaths since 1998, two of them in the last two The grounds of The Florida Institute for Neurologic Rehabilitation (FINR) in Wauchula. Photographer: Cathy Kemper via Bloomberg years. Three former employees face criminal charges of abusing FINR patients one of whom was allegedly hit repeatedly for two hours in a TV room last September. Florida s Department of Children and Families has received 514 allegations of abuse or neglect at FINR since 2005, including 37 that were verified by its investigations, according to records released by the agency. Investigators are still reviewing 23 of the claims. Amid the heightened regulatory scrutiny, 10 lobbyists from four different firms registered with Florida officials this month with the state to represent FINR, according to state records. No Reports The institute cited advice from its legal counsel in refusing regulators request for internal incident reports covering the past year, according to the state inspection report released today. The state on Aug. 10 issued a subpoena for those records. As of Wednesday, they hadn t been provided, according to the inspection report. State inspectors also found that an employee with a criminal background was working on the Florida Orders 1

20 residential staff and therefore was not eligible for employment. The report didn t include the employee s name. According to the state report, some FINR residents objected to being physically restrained by staff, echoing the complaints of patients interviewed by Bloomberg News. The state asked the facility to provide details on how it uses a procedure called Brief Assisted Required Relaxation and explain how patients are protected when restrained. The information released Thursday was an initial report and additional reviews of several other items continue, Michelle Dahnke, a spokeswoman for the Florida health-care agency, said in an . Potential Loss The potential loss of 50 patients or more would represent a substantial loss of revenue for the company. Individuals covered by the transitional living license are typically charged as much as $1,000 a day for their care, according to copies of bills reviewed by Bloomberg News. The Connecticut Department of Developmental Services said earlier this month that it is removing four of its 10 patients from the Florida facility. Miller, FINR s lawyer, said at the time that the patients vastly improved during their time in Florida and were well enough to return to their home state. FINR operates under three different types of licenses in Florida. The main one, for a transitional living facility, covers 143 of its 196 licensed beds. The others, which were not part of the state report released Thursday, cover several small group homes and a 25-bed nursing home license for patients requiring more intense medical care. Janet Clark, a former patient at The Florida Institute for Neurologic Rehabilitation (FINR) appears in this undated handout photo taken in Wauchula, Florida. Source: Janet Clark via Bloomberg Tougher Standards Disability Rights Florida, a federally-funded agency charged with investigating complaints of abuse against people with brain injuries and other disabilities, is pushing for tougher regulatory standards for FINR. Current rules governing the facility are too limited to ensure resident health, safety and prevention and detection of abuse, neglect and rights violations, the organization wrote in an Aug. 15 letter to AHCA Secretary Elizabeth Dudek. The disability rights group said there is no federal monitoring of the facility. FINR s Miller has previously said the institute is subject to intensive oversight and is regularly visited by police, state agencies, guardians, accrediting agencies and others. Editors: John Voskuhl, Gary Putka Florida Orders 2

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An unpublished opinion of the North Carolina Court of Appeals does not constitute controlling legal authority. Citation is disfavored, but may be permitted in accordance with the provisions of Rule 30(e)(3)

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Effective Date: September 23, 2013 THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. OUR PLEDGE

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JUVENILE JUSTICE SYSTEM A delinquency petition is a court document alleging that a juvenile, between ages 10-16, has violated a law which would be a criminal offense if committed by an adult. Disposition